| Background and Objective:Diffuse large B-cell lymphoma is the mostcommon non-Hodgkin ’s lymphoma subtype. Epidemiological has reportedDLBCL accounts for about30-40%of NHL in developed countries, andstatisctical results of collecting10,002cases from24centre in2011shewChina’s DLBCL accounted for45.8%of NHL and40.1%of all lymphomas.Middle-aged men always suffer from DLBCL, there is a wide age range,ofwhich average age is70years old, but is also found in children. Main clinicalsymptoms of DLBCL are painless lymphadenopathy,hectic fever, night sweatand other ones.There is significant heterogeneous in molecular, cytogenetics,clinical symptoms and disease outcome. So far its etiology has been unclear,most of DLBCL is originated in lymphatic tissus, and some can be secondaryfrom other low-grade malignant lymphoid tumors or a group of autoimmunediseases and immune deficiency diseases. DLBCL is a highly aggressive cancer,once diagnosised, treatments need be taken in time. By some activechemotherapy, approximately50%of patients can obtain clinical cure. Theadvent of rituximab made R-CHOP program emerged, and rituximab was alsonamed MabThera, which made the5-year survival of DLBCL patientsincreased to58%. But still many patients relapse soon after the end of treatment or progress during therapy. Relapse or progressive is a hot and difficult problemin the clinical researches, studies have reported that associated wtih immunetolerance of rituximab and immune escape of tumor related microenvirment,which may be one of the reasons of poor prognosis. Tumor microvironmentcytokines play an important role on treatment effects and prognosis. Somescholars have reported IDO(indoleamine2,3-dioxygenase) and CD47(Humanintegrin Associated Protein, IAP) related with threapy and prognosis of sometumors. This aim of study is to analysis correlation with expression of IDO orCD47in diffuse large B-cell lymphoma and clinicopathological features. Then,to preliminarily probe relationship between treatment response of standardprogram with R-CHOP and prognosis with expression of IDO and CD47indiffuse large B-cell lymphoma.Methods:63cases paraffin blocks filed included in my research wereselected from Department of Pathology, Sichuan Provincial Tumor Hospitalfrom Jan2007to Dec2012,which were devided into experiment group(41casesDLBCL)and control one(22case reactive hyperplasia). After reading sectionsagain, histological types of the samples were CD20-positive DLBCL andreactive hyperplasia which were confirmed by pathological diagnosis.Immunohistochemical Envision method was used to detect IDO and CD47expression levels in diffuse large B-cell lymphoma. Then we analyzed thecorrelations between IDO and CD47expression with clinicopathologicalfeatures in DLBCL. The datas were analyzed by chi-square test,Fisher exact probabilities test, Sperman rank correlation analysis,Log-rank univariatesurvival analysis and COX multivariate analysis by SPSS17.0.Results:(1)The positive expression rates of IDO and CD47in DLBCLwere56.1%and53.7%,respectively, which were higher than reactive lymphoidhyperplasia group(22.73%,13.6%). The difference was statisticallysignificant(P=0.011,0.003).(2)The expression of IDO related with Hans typeand B symptoms (X2=14.951,4.447,P=0.000,0.035); The expression level ofCD47correlated with clinical stage, ECOG score and B symptoms(X2=5.331,4.447,9.107,P=0.021,0.035,0.003); Short-term efficacy was relatedwith expression levels of IDO and CD47in DLBCL (Wilcoxon WTest,P=0.001,0.004). Expression level of IDO didn’t relate with age, sex, stage,number of extranodal involvement,IPI,ECOG and LDH of patients, there werenot significant relationship(P>0.05); Expression level of CD47didn’t relatewith age, gender, Hans type, number of extranodal involvement, IPI and LDHof patients, there were not significant relationship(P>0.05).(3)There was notrank correlation with between expression of IDO and CD47(r=0.096,P>0.05).(4)Log-rank univariate survival (progression free survival)analysis shew thatHans type, B symptoms, IPI, and expression of IDO and CD47werestatistically significant(P=0.003,0.000,0.030,0.009,0.027); but by COXmultivariate survival analysis, only expression level of IDO had a statisticalsignificance(P=0.024).Conclusions:(1)IDO and CD47were highly expressed in DLBCL, which suggested that could be involved with immune evasion from relatedlymphoma.(2)IDO and CD47expression levels may be used as an objectiveindicators for early prediction of R-CHOP treatment response and prognosis.Then to specially inhibit their expression, it is probable better to improveprognosis of low treatment response with R-CHOP.(3)there was no correlationbetween each other IDO and CD47, the reasons of which had to beenspeculated were small number of cases, indirect correlation between them, orother factors,so that adding the number of cases and further study on thespecific mechanisms would be done. |
PDF Full Text Request